Provider Demographics
NPI:1215209630
Name:LEE, STACY PHIPPS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:PHIPPS
Last Name:LEE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 W DIXON BLVD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-4351
Mailing Address - Country:US
Mailing Address - Phone:704-482-0336
Mailing Address - Fax:704-482-0749
Practice Address - Street 1:1830 W DIXON BLVD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-4351
Practice Address - Country:US
Practice Address - Phone:704-482-0336
Practice Address - Fax:704-482-0749
Is Sole Proprietor?:No
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0235291Medicaid